Treating ADHD in Women Is a Bloody Mess

Diagnoses are on the rise—and so are complaints that menstruation weakens treatment.

- Carrie Dennis

ON AN OTHERWISE forgettable Tuesday in early December, I opened the washing machine and was hit with the overwhelming smell of fish. I pulled out a pair of pajama pants, and the pocket was greasy with two ruptured softgels of cod-liver oil I'd forgotten to remove. The whole load reeked like a cast-iron skillet of seared salmon. I was furious I could be so stupid and careless.

I'd taken my lisdexamfetamine dimesylate, the generic version of Vyvanse, that morning, just as I had almost every day since I was diagnosed with ADHD a month earlier at age 35. The first time I swallowed the yellow capsule, I proceeded to paint my home office in two coats of White Dove, the result of a euphoric burst of energy that felt entirely new to me. The morning of the fish-pill incident, though, I felt so tired that I took a nap. I did not feel at all like I'd ingested a stimulant.

I blamed myself for my low energy and lack of focus. Maybe I hadn't slept well or eaten enough protein—or something? But a month later, I was again overwhelmed with fatigue, paralyzed by small tasks, and hating myself. And again the month after that. Trealized my meds seemed to stop working right before my period began.

Hormonal fluctuations in ADHD symptoms aren’t rare (on Reddit, a cadre of women commiserate over taking high doses of stimulant drugs that seem to work no better than sugar pills), but the scientific community has been slow to recognize them. One study found ADHD diagnoses in women ages 23 to 49 nearly doubled between 2020 and 2022, and another found a 14 percent increase in stimulant prescriptions for women and girls 5 to 64 between 2020 and 2021. That uptick has likely prompted more complaints about period-related dips in drug efficacy.